针药复合麻醉中不同频率电针对肺切除患者免疫功能的影响

目的:探讨针药复合麻醉中不同频率电针对肺切除患者的镇痛作用及其对免疫功能的影响,筛选针药复合麻醉中的最佳电针频率。方法:将163例择期行肺切除术患者随机分为A组(31例)、B组(34例)、C组(32例)、D组(34例)和E组(32例)。5组均穴取后溪、支沟、内关、合谷,A组采用假针刺,将无针体针灸针粘贴在穴位处,针柄连接电针;B组采用频率2Hz电针刺激;C组采用频率2Hz/100Hz的电针刺激;D组采用100Hz的电针刺激;E组采用经皮穴位电刺激,频率2Hz/100Hz,均诱导30min后行静脉诱导全身麻醉,术中维持电刺激至手术结束。观察术中麻醉药用量以及术前1天、术中和术后1天T淋巴细胞表面抗原(CD3+、CD4+、CD8+、CD4+/CD8+)和自然杀伤细胞(NK细胞)的变化。结果:丙泊酚用量B组和D组较少,芬太尼用量B组、D组、E组较少。各组CD3+、CD4+随着时间的变化呈现先增高后降低的趋势(均P<0.01),E组和C组相比其他3组能较好抑制术后CD3+、CD4+的降低(均P<0.05);各组CD8+随着时间的变化改变不大(均P>0.05),E组和D组相比其他3组能较好抑制术后CD8+的降低(均P<0.05)。各组CD4+/CD8+随着时间的变化改变不大(均P>0.05),E组、C组相比其他3组能较好抑制术后CD4+/CD8+的降低(均P<0.05)。各组NK细胞随着时间的变化呈现逐步增高的趋势(均P<0.01),各组对NK细胞的调节功能相当(均P>0.05)。结论:经穴2Hz、经穴100Hz和经皮穴位电刺激2Hz/100Hz在镇痛方面效果最佳。经皮穴位电刺激2Hz/100Hz和经穴2Hz/100Hz在免疫功能的调节方面作用最佳。推荐采用经皮穴位电刺激2Hz/100Hz,不仅能减少术中镇痛药用量,而且能明显改善肺切除手术患者的免疫抑制状态。

Influence of acupuncture-drug compound anesthesia with different frequency electroacupuncture on immune function in patients undergoing pneumonectomy

Objective To explore different frequency electroacupuncture in acupuncture-drug compound anesthesia on analgesic effect and immune function in the pulmonary resection patients in order to recommend the best electroacupuncture frequency in acupuncture-drug compound anesthesia.Methods One hundred and sixty-three patients scheduled for pneumonectomy were randomly divided into group A(n=31),B(n=34),C(n=32),D(n=34) and E(n=32).Houxi(SI 3),Zhigou(TE 6),Neiguan(PC 6) and Hegu(LI 4) were selected in the five groups.Group A was treated with sham acupuncture by pasting needles without needle bodies at acupoints and electroacupuncture at the needle handle,and group B with 2 Hz electroacupuncture,and group C with 2 Hz/100 Hz electroacupuncture,and group D with 100 Hz electroacupuncture,and group E with 2 Hz/100 Hz transce-taneous acupoints electrical stimulation,and general anesthesia was produced in all the groups followed by 30 min electrical stimulation and the stimulation was lasted till the end of operation.The dosages of the anesthetics and the changes of surface antigen of leukomonocyte(CD+3,CD+4,CD+ 8 and CD+4/CD+8) and natural killer(NK) cell were observed at 1 day before surgery,intraoperative and 1 day after surgery.Results In comparison with group A, the dosages of Propofol in group B and D were decreased,Fentanyl in group B,D and E were decreased.CD3+ and CD4+ in 5groups increased at first and then decreased over time(all P<0.01),and group E and C could inhibit the decrease of CD3+ and CD4+in postoperation in comparison with that in the other three groups(all P<0.05).CD8+ in 5 groups has no change in different times(all P>0.05),and group E and D could inhibit the decrease of CD8+ inpost operation in comparison with that in the other three groups(all P<0.05).CD4+/CD8+ in 5groups has nochange in different times(all P>0.05),and group E and C could inhibit the decrease of CD4+/CD8+ in postopera-tion in comparison with that in the other three groups(all P<0.05).NK cells of 5groups were increased gradually in different times(all P<0.01),with the similar regulation of NK cells(all P>0.05).Conclusion Acupuncture-drug compound anesthesia with 2Hz and 100Hz electroacupuncture together with 2Hz/100Hz transcetaneous acupoints electrical stimulation have the best analgesic effect,and 2Hz/100Hz transcetaneous acupoints electrical stimulation and 2Hz/100Hz electroacupuncture have the best regulation of immune function.Acupuncture-drug compound anesthesia with 2Hz/100Hz transcetaneous acupoints electrical stimulation is recommended for that it can not only decrease the dosages of the anesthetics,but also significantly improve the immunosuppression in patients undergoing pneumonectomy.